Risk factors for childhood diarrhea incidence - Dynamic analysis of a longitudinal study
Risk factors for childhood diarrhea incidence - Dynamic analysis of a longitudinal study
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DOI：
10.1097/01.ede.0000239728.75215.86
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发表时间：
2006-11-01
期刊：
影响因子：
5.4
通讯作者：
Barreto, Mauricio L.
中科院分区：
文献类型：
--
作者：
Genser, Bernd;Strina, Agostino;Barreto, Mauricio L.
背景：一些纵向研究调查了发展中国家儿童腹泻的相关因素。然而，大多数研究忽略了纵向设计的重要动态特征和潜在危险因素之间的层次相互关系。方法：我们在巴西东北部的一个大城市中心对902名0-36个月的儿童进行了纵向研究。从2000年10月至2002年1月，通过每两周一次的家访跟踪调查儿童，收集腹泻数据。我们使用动态事件间隔时间分析来解释几个纵向特征。结果：儿童的年龄和过去腹泻发作的自回归效应解释了整个研究中观察到的腹泻发病率下降的部分原因(从每儿童年超过14次腹泻到2次腹泻)，这一现象在其他纵向腹泻研究中已经观察到但没有解释。我们确定了以下主要的腹泻决定因素：社会经济地位低，卫生条件差，肠道寄生虫的存在，以及没有产前检查。社会经济地位的影响主要受生活和卫生条件的影响。结论：我们的研究显示了将动态分析方法应用于腹泻或其他急性疾病的纵向观察研究的重要优势，并突出了腹泻决定因素的复杂相互关系。我们的结果证实了卫生设施作为发展中国家城市环境中儿童健康的主要决定因素的重要性。
Background: Several longitudinal studies have investigated factors associated with childhood diarrhea in developing countries. However, most studies have neglected important dynamic features of the longitudinal design and hierarchical interrelationships among the potential risk factors.Methods: We conducted a longitudinal study of 902 children, age 0 to 36 months at baseline, in a large urban center in northeastern Brazil. Diarrhea data were collected by following children from October 2000 until January 2002 with biweekly home visits. We used a dynamic time-to-event analysis to account for several longitudinal features. We applied an effect-decomposition strategy to quantify direct and indirect effects of risk factors grouped in different blocks.Results: Child's age and an autoregressive effect of past diarrhea episodes explained some of the decline of diarrhea incidence observed throughout the study (from more than 14 episodes to 2 episodes per child-year), a phenomenon already observed but not explained in other longitudinal diarrhea studies. We identified the following major diarrhea determinants: low socioeconomic status, poor sanitation conditions, presence of intestinal parasites, and absence of prenatal examination. The effect of socioeconomic status was mediated mostly by living and sanitation conditions.Conclusion: Our study shows important advantages of applying a dynamic analysis approach to longitudinal observational studies of diarrhea or other acute diseases and highlights the complex interrelationships of diarrhea determinants. Our results confirm the importance of sanitation as a major determinant of child health in urban settings of developing countries.